Question: Have you ever had a patient say they experience metallic taste or smell prior to migraine episodes?
Experiencing unusual smells or taste can be a normal part of the migraine prodrome for some migraine individuals. Migraine attacks usually occur in stages and the initial stage for some Migraineurs is a “pre-headache” phase occurring for hours of days before the onset of aura or headache. The “pre-headache” phase is characterized by vague symptoms such as food cravings, elation, drowsiness, yawning and/or fatigue. This “pre-headache” phase can serve as a warning that a migraine is coming and may be an opportunity to get preventive management on board. This “pre-headache” phase is referred to as the “prodrome”.
Prodrome is different from aura. Prodrome precedes aura. During the aura phase of migraine, there are specific neurological signs and symptoms such as flashing lights, slurred speech, and tingling on one side of the body. Most aura symptoms last less than 1 hour. Premonitory symptoms that make up the prodrome are non-specific and can last for hours or days.
Craving chocolate is commonly reported before a migraine and may well be part of the prodrome. It is likely that chocolate is NOT a trigger for migraine as many think but rather part of the prodrome, i.e. the individual was already going to get a migraine and the chocolate was not the cause.
Experiencing a metallic taste or smell prior to a migraine attack is most likely part of this non-specific pre-headache phase of the prodrome. To be reassuring, it should resolve once the migraine occurs and not be experienced in between attacks.